Lorazepam/valproic acid
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Reactions 1473, p26 - 12 Oct 2013 X S Lorazepam/valproic acid Valproate-induced hyperammonaemic encephalopathy, followed by benzodiazepine withdrawal symptoms: case report A 57-year-old patient [sex not stated] who received valproic acid and lorazepam developed valproate-induced hyperammonaemic encephalopathy (VNHE), followed by benzodiazepine withdrawal symptoms. The patient experienced re-exacerbation of chronic schizoaffective disorder, and was hospitalised. The patient received valproic acid [dosage not stated] and lorazepam up to 6 mg/day [routes not stated]. After 8 days, the patient’s psychomotor agitation increased. The patient’s benzodiazepine dose was reduced because the patient became somnolent and stuporous. The patient was treated with flumazenil; vigilance improved. A benzodiazepine overdose was suspected. The patient’s valproic acid level was within the therapeutic range, but increased ammonia levels were detected. Valproic acid was withdrawn. A few hours later, the patient’s plasma ammonia level decreased. EEG revealed slow scattered theta and delta waves. The patient’s benzodiazepine dosage was increased because of severe benzodiazepine withdrawal, followed by rapid improvement of the withdrawal symptoms. The patient’s medication was switched to quetiapine and risperidone; a complete remission was achieved. A week later, EEG did not reveal any pathological results. Author comment: "Valproate-induced hyperammonemic encephalopathy (VNHE) is a rare, but severe, drug-related adverse effect . . . It occurs in monotherapy as well as in combination with other drugs. If the patient receives benzodiazepines simultaneously, the differential diagnosis may be more difficult . . . A synergetic effect of VHE and benzodiazepines on the patient’s vigilance is probably [sic] because of the positive effect of flumazenil in our patient". Sarlon J, et al. Valproate-induced hyperammonemic encephalopathy followed by benzodiazepine withdrawal in a patient with schizoaffective disorder: A differential diagnosis. Journal of Neuropsychiatry and Clinical Neurosciences 25: E69-E70, No. 3, 1 Jul 2013. Available from: URL: http://dx.doi.org/10.1176/ appi.neuropsych.12090218 - Germany 803094110 1 Reactions 12 Oct 2013 No. 1473 0114-9954/13/1473-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved
Transcript of Lorazepam/valproic acid
Reactions 1473, p26 - 12 Oct 2013
X SLorazepam/valproic acid
Valproate-induced hyperammonaemicencephalopathy, followed by benzodiazepinewithdrawal symptoms: case report
A 57-year-old patient [sex not stated] who received valproicacid and lorazepam developed valproate-inducedhyperammonaemic encephalopathy (VNHE), followed bybenzodiazepine withdrawal symptoms.
The patient experienced re-exacerbation of chronicschizoaffective disorder, and was hospitalised. The patientreceived valproic acid [dosage not stated] and lorazepam up to6 mg/day [routes not stated]. After 8 days, the patient’spsychomotor agitation increased. The patient’sbenzodiazepine dose was reduced because the patientbecame somnolent and stuporous. The patient was treatedwith flumazenil; vigilance improved. A benzodiazepineoverdose was suspected. The patient’s valproic acid level waswithin the therapeutic range, but increased ammonia levelswere detected.
Valproic acid was withdrawn. A few hours later, the patient’splasma ammonia level decreased. EEG revealed slow scatteredtheta and delta waves. The patient’s benzodiazepine dosagewas increased because of severe benzodiazepine withdrawal,followed by rapid improvement of the withdrawal symptoms.The patient’s medication was switched to quetiapine andrisperidone; a complete remission was achieved. A week later,EEG did not reveal any pathological results.
Author comment: "Valproate-induced hyperammonemicencephalopathy (VNHE) is a rare, but severe, drug-relatedadverse effect . . . It occurs in monotherapy as well as incombination with other drugs. If the patient receivesbenzodiazepines simultaneously, the differential diagnosismay be more difficult . . . A synergetic effect of VHE andbenzodiazepines on the patient’s vigilance is probably [sic]because of the positive effect of flumazenil in our patient".Sarlon J, et al. Valproate-induced hyperammonemic encephalopathy followed bybenzodiazepine withdrawal in a patient with schizoaffective disorder: A differentialdiagnosis. Journal of Neuropsychiatry and Clinical Neurosciences 25: E69-E70,No. 3, 1 Jul 2013. Available from: URL: http://dx.doi.org/10.1176/appi.neuropsych.12090218 - Germany 803094110
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Reactions 12 Oct 2013 No. 14730114-9954/13/1473-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved
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